Improved diagnostic accuracy for ulnar-sided TFCC lesions with radial reformation of 3D sequences in wrist MR arthrography

Abstract

Objectives Triangular fibrocartilage complex (TFCC) injuries frequently cause ulnar-sided wrist pain and can induce distal radioulnar joint instability. With its complex three-dimensional structure, diagnosis of TFCC lesions remains a challenging task even in MR arthrograms. The aim of this study was to assess the added diagnostic value of radial reformatting of isotropic 3D MRI datasets compared to standard planes after direct arthrography of the wrist. Methods Ninety-three patients underwent wrist MRI after fluoroscopy-guided multi-compartment arthrography. Two radiologists collectively analyzed two datasets of each MR arthrogram for TFCC injuries, with one set containing standard reconstructions of a 3D thin-slice sequence in axial, coronal and sagittal orientation, while the other set comprised an additional radial plane view with the rotating center positioned at the ulnar styloid. Surgical reports (whenever available) or radiological reports combined with clinical follow-up served as a standard of reference. In addition, diagnostic confidence and assessability of the central disc and ulnar-sided insertions were subjectively evaluated. Results Injuries of the articular disc, styloid and foveal ulnar attachment were present in 20 (23.7%), 10 (10.8%) and 9 (9.7%) patients. Additional radial planes increased diagnostic accuracy for lesions of the styloid (0.83 vs. 0.90; p = 0.016) and foveal (0.86 vs. 0.94; p = 0.039) insertion, whereas no improvement was identified for alterations of the central cartilage disc. Readers’ confidence (p < 0.001) and assessability of the ulnar-sided insertions (p < 0.001) were superior with ancillary radial reformatting. Conclusions Access to the radial plane view of isotropic 3D sequences in MR arthrography improves diagnostic accuracy and confidence for ulnar-sided TFCC lesions. Key Points • In multi-compartment arthrography of the wrist, ancillary radial plane view aids assessability of the foveal and styloid ulnar-sided insertions of the triangular fibrocartilage complex. • Assessment of peripheral TFCC injuries is more accurate with access to radial multiplanar reconstructions. • Additional radial planes provide greater diagnostic confidence.

Structurally intact and functionally incompetent foveal triangular fibrocartilage complex injuries

“…More recent techniques have demonstrated improved diagnostic accuracy for injuries localized to the fovea and styloid. 20 It is critical to understand, however, that while partial injuries may be reported as normal and structurally intact, the TFCC may be functionally incompetent in patients complaining of pain in the DRUJ (Figure 2).…”

Triangular fibrocartilage complex injuries – limitations of the current classification systems and the proposed new ‘CUP’ classification

“…Type U2 lesions are avulsions of the deep (foveal) lamina of the radioulnar ligaments from the ulnar fovea. They can be reliably assessed with arthroscopy of the distal radioulnar joint (Atzei and Luchetti, 2011; Nakamura et al., 2011; Slutsky, 2004) and with MR arthrography (Daunt et al., 2021; Huflage et al., 2021; Lee et al., 2013) or CT arthrography (Grunz et al., 2020). Because U2 tears lead to instability of the distal radioulnar joint, surgical refixation is indicated as treatment (Atzei et al., 2017; Nakamura et al., 2011).…”

Evaluation of prestyloid recess morphology and ulnar-sided contrast leakage in CT arthrography of the wrist

“…In the presence of ulnar-sided wrist symptoms, diagnostic imaging is usually focused on the triangular fibrocartilage complex (TFCC) with its articular disc, the dorsal and palmar radioulnar ligaments, as well as their peripheral insertions at the ulnar styloid process and in the ulnar fovea [1,2]. However, despite their importance for the stability of the distal radioulnar joint (DRUJ), these components of the TFCC are not the only anatomical structures capable of causing ulnar-sided wrist pain [3].…”